I've written about health care for more than two decades, starting from my native Iowa where I covered the presidential campaign bus rides of Bill and Hillary Clinton through the Hawkeye state talking health reform and the economy. I have covered the rise, fall and rise again of health reform, chronicling national trends as well as the influence of Barack and Michelle Obama from Chicago's South Side on changes to the U.S. health system from my base in Chicago. I am the author of the new Forbes signature series book, "Inside Obamacare: The Fix For America's Ailing Health Care System." I was health care business reporter at the Chicago Tribune (1998-2011) and previously wrote for Modern Healthcare magazine when first arriving in Chicago in 1993. Prior to that, I wrote for several Iowa newspapers including the Des Moines Register. These days, I contribute stories to the New York Times, Chicago Medicine magazine and teach in the University of Iowa School of Journalism MA in Strategic Communication program. You can see me nationally on Fox News Channel's "Forbes on Fox" show. In Chicago, you can hear my health segments and business analysis on WBBM newsradio 780 and 105.9 FM. I am passionate about health literacy when it comes to explaining the complexities of health care. A better understood health system may save someone some money or their life.

Obamacare Rolls Out Hospice Care Penalties And Quality Focus

Providers of hospice care, which will be caring for a booming population of aging baby boomers, were told Friday they get a 1 percent pay raise and a mandate to report quality measures to the U.S. government or essentially lose that raise come Oct. 1. In this photo, an elder care nurse works in India.(Image credit: AFP/Getty Images via @daylife)

Providers of hospice care, which will be caring for a booming population of aging baby boomers, were told they get a 1 percent pay raise from the Medicare program and a mandate to report quality measures to the U.S. government or essentially lose that raise come Oct. 1.

The move comes at a time hospitals, doctors and providers of medical-care of all kinds are being coaxed away from fee-for-service medicine to an era when they are paid base on the value of medical care that they provide. Translation: they must provide quality care or be punished in the form of less payment.

For now, hospice providers merely have to report the data. Unlike health insurance companies and others, there are no ratings that have been issued to hospice providers from the Centers for Medicare & Medicaid Services. It’s called the “Hospice Quality Reporting Program” and specifics can be found at this link here.

“(The Centers for Medicare & Medicaid Services’) goal is to adopt measures for the Hospice Quality Reporting Program that ensure care is patient and family-centered and is safe and high-quality,” Dr. Patrick Conway, chief medical officer and director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services told Life Matters Media last week. “It is critical that hospice providers meet the care needs of all patients and families.”

The Centers for Medicare & Medicaid Services on Friday issued the final rule on hospice payments and the upcoming quality reporting requirements on Friday.

“Hospices will be required to begin using the survey in 2015,” the Centers for Medicare & Medicaid Services said.

The momentum behind quality reporting in hospices comes as both the government and private insurers and employers contract with entities that measure quality and push for better outcomes through entities like accountable care organizations (ACOs), which are created by providers of medical care to contract with insurance companies like AetnaAetna (AET), UnitedHealth GroupUnitedHealth Group (UNH), HumanaHumana (HUM) and CignaCigna (CI) among others. If the ACO reduces costs while improving quality, the providers keep some of the savings. That is different than payment today that encourages excessive treatment by paying by procedure.

“The survey will include questions on hospice provider communications with patients and families, hospice provider care, and overall rating of hospice,” the Centers for Medicare & Medicaid Services said. “CMS will include participation in the survey as a quality-reporting requirement for hospices to receive their full annual payment update beginning in FY 2017.”

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When has government involvement ever resulted in improving efficiency of delivering a service that has resulted in cost savings ? The answer should be self evident. But in the words of Nancy Pelosi… “lets pass the bill so we can read what’s in it”. So bring up YouTube and listen to the verbatim reading of the ACA so you can appreciate just how convoluted it is. End result thousand upon thousands pages of regulations that have no end in sight. Thought the tax code was complicated ? Think again

According to CMS, for common benefits, Medicare spending rose by an average of 4.3 percent each year between 1997 and 2009, while private insurance premiums grew at a rate of 6.5 percent per year.

According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.

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Then you have insurers like United Healthcare with their blind and tiered subsidiaries that are already cashing in on hospice for profit like Evercare. I just went through using a hospice service for my mother who passed away and thank goodness I saw this was a subsidiary of United and chose a non profit, which was excellent to take care of my mother.

So with Evercare United gets both sides of it and if you look at the want ads they are advertising all over the place for nurses and other hospice workers.

Big insurers operate under the radar and make money as with this company all over in healthcare, take a look at the SEC filings which shows a ton of tiered subsidiaries but not all as the SEC rules state that subsidiaries only need to be listed if they are a “substantial operation”….and there are rules that go along with those provisions. Evercare is an interesting United subsidiary as it is listed as a sub in a couple different ways.

Something had to change. It will need tweaking but at least its a start. Stop whining about every little thing and things ill be better that what we currently have. It takes 2 to 3 yrs to fix bugs in any type of program this large. Even the countries that rate far above the US in healthcare and life expectancy had to work out the kinds the first few years. But their end result was well worth it.

Hey socialist! Some people still liked having a choice, rather than being forced to pay for a service or end up getting fined! If you think that the IRS is not going to end up screwing everyone over even more than they already do, you are a sucker.